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SHRUTI

An innovative ear care programme to deliver awareness, screening, diagnosis, and treatment for the underserved.

A recent World Health Organization report states that millions of people in the world have hearing loss that can be treated or prevented. More than 360 million people live with disabling hearing loss, which is almost 5.3% of the world population.1 India is estimated to have a hearing-disabled population of 63 million.2 Of the many causes of hearing impairment, middle ear infection is one of the important but preventable causes.

Medical experts recommend seeking immediate medical advice for any ear infections. These can be easily detected through a simple examination of the ears by a doctor using an oto-endoscope. With early screening and diagnosis, most diseases of the ear are curable either medically or surgically.

Medtronic launched “Shruti” in July 2013 with a philosophy to create sustainable program of low-cost otology care including awareness, screening, diagnosis, and treatment to the underserved, particularly in densely populated, low-income urban settlements and rural areas by leveraging medical technology, telecommunication, and frugal innovation. It is a hallmark example of health system innovation, serving dual objects of social impact and business viability simultaneously.

With an ENT surgeon as the central point of care, the programs are operationalized through trained community health workers (CHW) equipped with an “Ear Screening Kit.” Patients with a positive provisional diagnosis are routed to the point of care for receiving low-cost treatment, including advanced diagnosis,medicines, audiometric tests and surgical interventions.

Ear Screening Kit

The Ear Screening Kit, now in its third generation, is a CE certified production-version. It consists of four components: an otoscope, a digital image capturing and transmitting device (smartphone), a light source for the otoscope, and a mobile data SIM card. A telemedicine application is loaded onto the device to record an entire case, including images of the ear and provisional diagnosis. The completed test is then transmitted to a cloud server over 3G which can be accessed by the ENT surgeon.

How it works :

Specially trained community health workers are equipped with an innovative field ear screening kit called ENTraview and deployed in low- income urban communities and rural areas. The customized application enables the health workers to gather patients details, complaints and other information including an image of the tympanic membrane, with a built-in algorithm for field triaging of ear diseases including infections, impacted wax, foreign body etc. A WHO based field evaluation helps them to identify population with diminished hearing. The complete patient case recorded via this application is transmitted to a server where an ENT surgeon can access the case and recommend the next course of action.

Treatment includes medical management, minor procedures, surgical intervention and rehabilitation. Current Shruti care network includes charitable as well as for profit hospitals, ENT Surgeons and government tertiary care centers. Community workers hired for the programme are trained for over four weeks using specially developed curriculum based on recommendations from ENT Surgeons and WHO. The training includes basics in ear anatomy, hearing loss conditions and causes, middle ear infection, and identifying an unhealthy ear drum. They also receive practical experience by working closely with ENT surgeons and paramedical teams coupled with use of the Shruti kit.

Current Status

Residents from underserved communities in and around Delhi are screened at convenient community locations by trained health workers using the Shruti screening and diagnosis kit developed by Medtronic partners. A telemedicine application transmits images of the patient’s middle ear via a smart phone to the Shruti programme staff and an ENT surgeon via a smart phone. Any complex infections and hearing loss diagnosed are referred to an ENT for treatment and potential surgery.

Shruti Program is currently operational across seven self-funded cities in Delhi, Gurgaon, Faridabad, Hyderabad, Aurangabad, Jaipur, Chennai and Dhaka (Bangladesh). As of February 2017, through community health workers, the program has screened more than 2,70,000 people. Over 25% of screened population needs some form of ear care, about 8% population need a combination of medical and surgical intervention and 3-5 % population need hearing aids.